“Pediatricians and child psychiatrists would see kids who could talk but who had social discomfort — severe social discomfort — and awkwardness and a very restricted and impairing level of interests and activities, and they wanted a diagnosis for this,” Frances says.

A study was done to figure out how common Asperger’s was, and the results were clear: It was vanishingly rare. Then Frances put it in the DSM, and the number of kids diagnosed with the disorder exploded. Frances remembers sitting in his condo reading articles about this new epidemic of Asperger’s that was sweeping the nation.

“At that point I did an ‘oops,’ ” he says. “This is a complete misunderstanding.

Specifically, DSM-5 will continue to use symptoms as the primary way to decide whether a person has a particular disorder. That may not sound odd until you consider what’s happened in other fields of medicine, like cardiology.

The Hippo Problem

But now, many scientists are concerned that this emphasis on the signs and symptoms of a disease “could be seen as holding us back,” Desmond-Hellman says. Instead, she’s been advocating something called “precision medicine,” which tries to classify diseases in a way that indicates what’s truly causing the problem.

The human brain is the most complicated thing in the universe. It has nearly 100 billion neurons and many trillions of connections, and its complex wiring changes all the time.

A Guide to DSM-5: Substance Use Disorder
Bret S. Stetka, MD, Christoph U. Correll, MD
May 21, 2013http://www.medscape.com/viewarticle/803884_11
{“addictions and related disorders” is not the wording used in the final DSM-5 version}

All the DSM disorders overlap with one another and frequently also with normality.
For example, there is no clear boundary between bipolar and unipolar mood disorder, between anxiety and depression, even between schizophrenic and psychotic mood disorders, and so on throughout all the sections.

grief, once excluded from the definition of depression, is now included within it.
This means that people grieving over the death of a loved one could theoretically go to their psychiatrist and be prescribed pills to treat the “condition.”

The Lancet beautifully outlines why the medicalization of grief is misguided for so many reasons.
Antidepressants don’t do anything to the moods of non-depressed people, they point out, so there’s little likelihood that they would work to reduce grief.
Arthur Kleinman, a medical anthropologist, says that since the APA wants to allow for treatment of the normal grieving process, it had to first yank it from Normalcy and plunk it down in the realm of Abnormal, or worse, “make it over into a disease—ie, depression.”

the DSM continues to shorten the normal grieving processes.
The DSM-III considered grief for up to one year acceptable, the DSM-IV only two months.
No other culture, Kleinman says, considers two months a normal amount of time to grieve. They must be shaking their heads at us silly Americans and our strange attitude towards grief. Cultures across the globe vary hugely in what’s considered a normal timeframe to grieve, some devoting the remainder of the lifespan to mourning the loss of a loved one.

a fundamental difference between grief and clinical depression: grief, in many ways, makes sense, as there is direct cause for the feelings of sadness, loss, sleeplessness, and lack of concentration.

Would you want to take a medication if it would help lighten the pain of grief?
Or is it better to experience it, work through it, and wait for it to lift in its own time?
There is undoubtedly a place where grief becomes depression when it does not lighten for a long time.
But considering it a symptom of depression from day one seems like a damaging way to define it.

When a young person experiences a frightening break from reality, Western experts usually label it a “first-episode psychosis”, while many psychologists and cultures define it as a “spiritual awakening.

diagnosed with several disorders, or co-morbidities: About one-fifth of people who fulfil criteria for one DSM-IV disorder meet the criteria for at least two more.
These are patients “who have not read the textbook”

Psychiatrists see so many people with co-morbidities that they have even created new categories to account for some of them.
The classic Kraepelian theoretical division between schizophrenia and bipolar disorder, for example, has long been bridged by a pragmatic hybrid called schizoaffective disorder, which describes those with symptoms of both disorders and was recognized in DSM–IV.

Ironically, the ingrained category approach is actually inhibiting the scientific research that could refine diagnoses, in part because funding agencies have often favoured studies that fit the standard diagnostic groups.
“Until a few years ago we simply would not have been able to get a gra nt to study psychoses,” says Nick Craddock, who works at the Medical Research Council Centre for Neuropsychiatric Genetics and Genomics at Cardiff University, UK.
“Researchers studied bipolar disorder or they studied schizophrenia. It was unthinkable to study them together.”

“Introducing a botched dimensional system prematurely into DSM-5 may have the negative effect of poisoning the well for their future acceptance by clinicians,” wrote Allen Frances, emeritus professor of psychiatry at Duke University in Durham, North Carolina, in an article in the British Journal of Psychiatry

The controversial personality-disorder dimensions were voted down by the APA’s board of trustees at the final planning meeting in December 2012.

The APA claims that the final version of DSM-5 is a significant advance on the previous edition and that it uses a combination of category and dimensional diagnoses.
The previously separate categories of substance abuse and substance dependence are merged into the new diagnosis of substance-use disorder.

Bodurka’s group is studying the idea that dysfunctional brain circuits trigger the release of inflammatory cytokines and that these drive anhedonia by suppressing motivation and pleasure.
The scientists plan to probe these links using analyses of gene expression and brain scans. In theory, if this or other mechanisms of anhedonia could be identified, patients could be tested for them and treated, whether they have a DSM diagnosis or not.

On the question of dimensionality, most outsiders see it as largely the same as DSM-IV. Kupfer and Regier say that much of the work on dimensionality that did not make the final cut is included in the section of the manual intended to provoke further discussion and research.

All involved agree on one thing.
Their role model now is not Freud or Kraepelin, but the genetic revolution taking place in oncology.
Here, researchers and physicians are starting to classify and treat cancers on the basis of a tumour’s detailed genetic profile rather than the part of the body in which it grows.
Those in the psychiatric field say that genetics and brain imaging could do the same for diagnoses in mental health.

As Holly Prigerson, a researcher at Harvard University who studies bereavement says, “What underlies a lot of this discussion is: Is it harmful to interrupt a normal grief process by medicating?”Medicalizing Our Experiences But for some people, the real issue raised by the bereavement exclusion is philosophical — or maybe the better word is existential. Dr. Allen Frances, the famous psychiatrist and a former editor of the DSM, says that more and more, psychiatry is medicalizing our experiences. That is, it is turning emotions that are perfectly normal into something pathological. “Over the course of time, we’ve become looser in applying the term ‘mental disorder’ to the expectable aches and pains and sufferings of everyday life,” Frances says. “And always, we think about a medication treatment for each and every problem.” From Frances’ perspective, if you can’t feel intense emotional pain in the wake of the death of your child without it being categorized as a mental disorder, then when in the course of human experience are you allowed to feel intense emotional pain for more than two weeks?

see also:

The Power of Mindfulness: What You Practice Grows Stronger
Shauna Shapiro
TEDxWashingtonSquare
cortical thickening
I’m not good enough
shame